Economic evaluation of Indigenous health worker management of poorly controlled type 2 diabetes in north Queensland

Segal, Leonie, Nguyen, Ha, Schmidt, Barbara, Wenitong, Mark, and McDermott, Robyn A. (2016) Economic evaluation of Indigenous health worker management of poorly controlled type 2 diabetes in north Queensland. Medical Journal of Australia, 204 (5). e1-e9.

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Abstract

Objective: To conduct an economic evaluation of intensive management by Indigenous health workers (IHWs) of Indigenous adults with poorly controlled type 2 diabetes in rural and remote north Queensland.

Design: Cost–consequence analysis alongside a cluster randomised controlled trial of an intervention delivered between 1 March 2012 and 5 September 2013.

Setting: Twelve primary health care services in rural and remote north Queensland communities with predominantly Indigenous populations.

Participants: Indigenous adults with poorly controlled type 2 diabetes (HbA₁(c) ≥ 69 mmol/mol) and at least one comorbidity (87 people in six IHW-supported communities (IHW-S); 106 in six usual care (UC) communities).

Main outcome measures: Per person cost of the intervention; differential changes in mean HbA₁(c) levels, percentage with extremely poor HbA₁(c) level control, quality of life, disease progression, and number of hospitalisations.

Results: The mean cost of the 18-month intervention trial was $10 060 per person ($6706 per year). The intervention was associated with a non-significantly greater reduction in mean HbA₁(c) levels in the IHW-S group (–10.1 mmol/mol v –5.4 mmol/mol in the UC group; P = 0.17), a significant reduction in the proportion with extremely poor diabetes control (HbA₁(c) ≥ 102 mmol/mol; P = 0.002), and a sub-significant differential reduction in hospitalisation rates for type 2 diabetes as primary diagnosis (–0.09 admissions/person/year; P = 0.06), with a net reduction in mean annual hospital costs of $646/person (P = 0.07). Quality of life utility scores declined in both groups (between-group difference, P = 0.62). Rates of disease progression were high in both groups (between-group difference, P = 0.73).

Conclusion: Relative to the high cost of the intervention, the IHW-S model as implemented is probably a poor investment. Incremental cost-effectiveness might be improved by a higher caseload per IHW, a longer evaluation time frame, and improved service integration. Further approaches to improving chronic disease outcomes in this very unwell population need to be explored, including holistic approaches that address the complex psychosocial, pathophysiological and environmental problems of highly disadvantaged populations.

Item ID: 46153
Item Type: Article (Refereed Research - C1)
ISSN: 1326-5377
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC Program Grant 631947, NHMRC Partnership Grant 570149
Date Deposited: 24 Oct 2016 00:13
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111709 Health Care Administration @ 50%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920104 Diabetes @ 50%
92 HEALTH > 9203 Indigenous Health > 920302 Aboriginal and Torres Strait Islander Health - Health Status and Outcomes @ 50%
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